Browsing by Author "Bhatta, Narendra"
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Publication Amiodarone Induced Interstitial Lung Disease: An Enigma(Nepalese Respiratory Society, 2024) Aryal, Prakash; Pantha, Srijan; Gurung, Kum Bahadur; Uprety, Augraj; Shah, Nensi; Timsina, Anup; Mandal, Dipesh; Yadav, Krishna Chandra; Adhikari, Aarati; Shahi, Rejina; Mishra, Deebya Raj; Bhatta, NarendraAbstract: Amiodarone is an anti-arrhythmic drug that has potential to cause Interstitial Lung Disease (ILD) commonly non-specific Interistitial pneumonia. We present a 75-year male presenting with gradual onset progressive shortness of breath and dry cough after undergoing coronary artery bypass grafting (CABG) and was kept on amiodarone therapy post-surgery to control arrhythmias. The patient was diagnosed as amiodarone induced Non-Specific Interstitial Pneumonia (NSIP) after excluding alternative diagnosis. Early recognition and stoppage of amiodarone, prompt treatment with corticosteroid and respiratory support had favorable clinical outcome in this case.Publication Anthropometric and Nutritional status of Chronic Obstructive Pulmonary Disease presenting in Acute Exacerbation in Tertiary care Hospital in Eastern Nepal(Nepalese Respiratory Society, 2024) Uprety, Augraj; Pantha, Srijan; Gurung, Kum Bahadur; Aryal, Prakash; Timsina, Anup; Mandal, Dipesh; Hamal, Sangita; Chaudhary, Sabnam; Thakur, Aanad Lohar; Yadav, Krishna Chandra; Shah, Nensi; Yadav, Dipendra; Pandey, Prajwal; Dahal, Sweta; Shahi, Rejina; Mishra, Deebya Raj; Bhatta, NarendraAbstract: Background: There is scarcity of data regarding the nutritional status of COPD patients presenting in exacerbation in our setup, thus this observational study was conducted. Methods: We performed an observational study of patients with acute exacerbation of COPD, who were admitted in the Department of Pulmonary, Critical care and Sleep Medicine in tertiary hospital in eastern Nepal from April 2023 to June 2023. Results: During the study period, a total of 154 patients of COPD with exacerbations were admitted in our department. The baseline anthropometric parameters, lab parameters as well as the malnutrition scores were determined. The mean BMI was 21.82 ± 3.92 kg/m2 and only 29% had BMI < 18.5 kg/m2.The mean hemoglobin, mean cell volume, serum protein, serum albumin, serum calcium, phosphorus and vitamin D level were 12.43 ± 2.32 g/dL, 84.4 ± 9.41 fL, 6.42 ± 1.74 g/ dL, 3.32 ± 0.34 g/dL, 8.98 ± 0.63 mg/dL, 3.02 ± 0.42 mg/dL, 18.48 ± 8.22 pg/mL and 40%, 12%, 28%, 41%, 31%, 42% and 49% of these values were below the lower normal limit respectively. The nutritional status tool used NRS-2002, MUST and MNAS-F screened malnutrition in about 68%, 51% and 54% respectively. There shows a discrepancy between the evaluation of the malnutrition assessed by BMI with that of nutritional assessment score. Conclusion: COPD who present in exacerbations are malnourished, but use of sole BMI to rule out malnutrition in such group of patients can cause false negative result.Publication Evaluation of the diagnostic yield of lung cancer on various Bronchoscopic modalities Authors(Nepalese Respiratory Society, 2023) Shahi, Rejina; Bhatta, Narendra; Verma, Avatar; Upreti, Augraj; Gurung, Kum Bahadur; Chaudhary, Sabnam; Dhakal, Nishchal; Mishra, Deebya RajAbstract: Background: The application of cytological techniques in identifying malignant respiratory tract lesions has been widely praised as a significant achievement. Flexible fiberoptic bronchoscopy has greatly transformed respiratory cytology, making procedures such as bronchial brushings, broncho-alveolar lavage, and bronchial forceps biopsy more convenient, accessible, and popular. Methodology: All the suspected cases of lung cancer from 1st Jan, 2020 - 31st Dec, 2022 fulfilling inclusion criteria who have undergone flexible bronchoscopy in our center have been analyzed and enrolled in the study. Results: Out of 90 patients, 85 were found to be malignant. Squamous cell carcinoma was the most common carcinoma (31.1%) followed by adenocarcinoma (26.7%), non-small Cell Lung Carcinoma (17.8%) and small cell carcinoma (12.2%), majority of the cases were of 6-7th decade of life and were smoker. Sensitivities of Bronchoalveolar Lavage (BAL), Bronchial brush, Endobronchial forceps Biopsy (EBB), Transbronchial Lung Biopsy (TBLB) and Transbronchial Needle Aspiration (TBNA) were found to be 32%, 87%, 83%, 55% and 69% respectively. Diagnostic accuracy of BAL, bronchial brush, EBB, TBLB and TBNA were found to be 36%, 87%, 83%, 55% and 61% respectively. Conclusion: With a greater sensitivity (87%) and diagnostic accuracy (87%), bronchial brushing shows great promise as a convenient cytological technique suitable for screening ambiguous cases and early detection of lung cancer, as it saves the time required for processing biopsy samples.Publication Metabolic Signature and Obstructive Sleep Apnea in Nepalese Patients(Nepalese Respiratory Society, 2023) Verma, Avatar; Bhatta, Narendra; Mishra, Deebya Raj; Shahi, Rejina; Uprety, Augraj; Aryal, Prakash; Yadav, Devesh Kumar; Lama, UrmilaAbstract: Introduction: Untreated Obstructive Sleep Apnea (OSA) causes sleep related symptoms and also causes increased incidence of RTA, cardiovascular diseases and all cause mortality. Currently OSA has been recognized as the consequence of number of interrelated metabolic and oxidative pathologies. As there are limited data of association of OSA with metabolic stress and its correlation with severity of OSA, study of metabolic profile of these patients in view of defining the Metabolic signature of OSA was carried out in eastern Nepal. Objectives: To study metabolic profile of OSA and its association with clinical severity. Methods: Hospital based descriptive cross sectional study. Biochemical profile results related to metabolic –oxidative pathway of the OSA patients were obtained. Quantitative and qualitative data were obtained. Quantitative data were compared using Mann–Whitney test while qualitative variables compared using Pearson χ2. Correlation was carried out using Pearson and Spearman’s test. P-value<0.05 considered significant. Results: 33 patients of OSA were enrolled. Majority of patients had deranged metabolic and oxidative parameters despite mild OSA. Among metabolic stress parameters, most commonly deranged were decreased high density lipoprotein (HDL), increased mean arterial pressure (MAP), waist circumference (WC) and raised fasting blood sugar (FBS). Increased MAP and increased WC was significantly corelated with severity. Conclusion: Besides symptom complex, OSA is also harbinger of metabolic stress that can lead to various cardiometabolic diseases and premature mortality thus early recognition and treatment can mitigate these consequences.Publication Ultrasound-Guided Percutaneous Transthoracic Biopsy by Pulmonologists(Nepalese Respiratory Society, 2024) Verma, Avatar; Bhatta, Narendra; Shahi, Rejina; Lama, Urmila; Aryal, Prakash; Pantha, Srijan; Hamal, Sangita; Mishra, Deebya RajAbstract: Background: Ultrasound-guided transthoracic needle biopsy (USG-TTNB) is a simple and safe procedure carried out to obtain a tissue sample for confirmation of the diagnosis of various thoracic pathologies. These procedures are usually carried out by radiologists in our country. However, there is good efficacy and fewer complications even in the hands of chest physicians, as shown by many studies published abroad. Considering this, the study is carried out to evaluate outcomes of USG-TTNB by pulmonologists in Nepal. Objective: To study the efficacy and complications associated with USG-guided transthoracic needle biopsies performed by pulmonologists. Methods: Retrospective analysis of 77 patients undergoing USG-TTNB by pulmonologists at BPKIHS from November 2019 to November 2023 were analyzed. The efficacy of the procedure and the complication rate were derived. Efficacy was calculated as proportion of the patients who had undergone the biopsy and resulted in a clinically contributory specimen. Results: Mean age: 62.5 ± 13.7 years; 63.6% female. Transthoracic Fine Needle Aspiration showed a diagnostic yield of 82.6 % of patients, whereas that of trucut biopsy was 86.7 % with a combined diagnostic yield of 94 %. Pneumothorax occurred in four (5.2 %) of patients, and hemothorax occurred in two (2.6 %) of patients. Conclusion: USG-guided percutaneous transthoracic biopsy by a pulmonologist is a procedure with good diagnostic yield and a lower complication rate.Publication Varicella Pneumonia in Young Adult Male: A Case Report(Nepalese Respiratory Society, 2024) Uprety, Augraj; Pantha, Srijan; Gurung, Kum Bahadur; Aryal, Prakash; Timsina, Anup; Mandal, Dipesh; Yadav, Krishna Chandra; Shah, Nensi; Yadav, Dipendra; Pandey, Prajwal; Dahal, Sweta; Shahi, Rejina; Mishra, Deebya Raj; Bhatta, NarendraAbstract: Varicella infection is a common disease in pediatric age group but is uncommon in adult. Varicella pneumonia is the dreaded complication in these patients leading to mortality, which is more pronounced in adult patients. This is a case report of a young adult male, presenting with Varicella pneumonia in severe hypoxic respiratory failure, which was successfully managed with oxygen therapy, acyclovir, and steroids.